| Objective(1)Based on a comprehensive search of the literature on moxibustion treating chronic low back pain,systematic review and Meta-analysis was conducted to assess the effect of moxibustion for chronic low back pain(LBP)with the available evidence from randomized controlled trials(RCTs).(2)By comparing the effects of different moxibustion duration on lumbar disc herniation(LDH),the best duration of moxibustion was discussed in order to find moxibustion operation method based on the best curative effect and provide some reference for clinical moxibustion operation.Methods:(1)Systematic review:A comprehensive search of the Cochrane Library,Web of Science,PubMed,Embase,EBSCO,CBM,Wanfang,CNKI and VIP(until November,2019)was conducted to identify studies reporting low back pain(VAS or NRS),disability(ODI or RMDQ),JOA score,and quality of life(SF-36)in patients with CLBP.Two reviewers carried out study selection and data extraction independently.Adopt Cochrane criteria for risk of bias to evaluate included trials’ methodological quality and apply the Grading of Recommendations Assessment,Development,and Evaluation Methodology(GRADE)to assess the quality of evidence from the quantitative analysis.(2)Clinical study on effect of different moxibustion duration on lumbar disc herniation:88 eligible LDH patients was divided into four groups with 22 patients each group.The control group was intervened with conventional western medicine treatment and the other three groups were intervened with different moxibustion time on the basis of the control group intervention.Low back pain,lumbar range of motion,dysfunction and Lumbar function of patients in four groups was evaluated at before intervention,1 week and 2 weeks after intervention,respectively.Response rate was assessed at 2 weeks after intervention.Adverse effects were observed and recorded at any time during the whole treatment process.Results(1)Systematic review:Ten RCTs,including 987 patients,met the inclusion criteria.①Low back pain:Moxibustion had a superior effect on VAS score when compared with western medicine[MD=-1.69,95%CI(-2.40,-0.98),p<0.00001]and acupuncture[MD=-0.47,95%CI(-0.92,-0.02),p=0.04],but it failed to do so when compared with core stability training[MD=-0.41,95%CI(-0.87,0.05),p=0.08].The result showed that moxibustion plus other active treatments(including western medicine,massage,acupuncture and core stability training)had better effects on low back pain relief compared with active treatments alone.②Disability:Moxibustion showed favorable effects on disability[SMD=-3.80,95%CI(-5.49,-2.11),p<0.0001].③JOA score:Compared with other intervention methods,moxibustion can significantly increase JOA score of patients[MD=4.10,95%CI(2.30,5.90),p<0.00001].③Quality of life:Moxibustion has more superior effects on improving patients’quality of life when compared with other intervention methods[MD=13.41,95%CI(9.68,17.14),p<0.00001].The evidence level of results from the ten studies was determined to be very low to low.(2)Clinical study on effect of different moxibustion duration on lumbar disc herniation:①Low back pain:adopt VAS score.There was no significance between control group and moxibustion 15min group(p>0.05),while the VAS score of moxibustion 30min and 45min groups decreased significantly when compared with that of control group and moxibustion 15min group(p<0.05).It showed no significance between moxibustion 30min and 45min groups on VAS score(p>0.05).②Lumbar range of motion:use MMST and Lumbar function MMST:Compared with the control group,MMST of moxibustion 15min group did not increased significantly(p>0.05),but the MMST of moxibustion 30min and 45min groups increased significantly(p<0.05).It showed no significance on MMST among moxibustion 15min,30min and 45min groups.③Dysfunction:adopt RMDQ score.Compared with the control group,the RMDQ score of patients in moxibustion 15min group,30min group and 45min group reduced significantly(p<0.05).RMDQ score of moxibustion 30min group and 45min group were significantly decreased when compared to moxibustion 15min group(p<0.05).However,there is no significance between moxibustion 30min and 45min groups(p>0.05).④Lumbar function:use JOA score.Compared with the control group,JOA score of moxibustion 15min,30min and 45min groups improved significantly(p<0.05)and that of moxibustion 30min group and 45min group also increased when compared to moxibustion 15min group(p<0.05).However,it showed no significance between moxibustion 30min and 45min groups(p>0.05).⑤Response rate:The response rate of moxibustion for 30min and 45min groups showed better than that of control group(p<0.05),but there was no significance between control group and moxibustion 15min group(p>0.05).It showed no significance among moxibustion groups for 15min、30min and 45min on response rate(p>0.05).⑥Adverse effects:In moxibustion 45min group,one patient’s skin appeared a slight blush during one of a moxibustion operation.The moxibustion was withdrawn on the same day,but continued to be treated with moxibustion next day.No adverse reactions occurred in other groups.Conclusions(1)Systematic review:It is difficult to draw firm conclusion that moxibustion is an effective intervention for treating chronic low back pain due to the small sample size of eligible trails and the high risk of bias among the available included studies.More well designed large-scale RCTs are required to verify the results in our study.(2)Clinical study on effect of different moxibustion duration on lumbar disc herniation:Moxibustion has good effects on lumbar disc herniation,and the effect will be better with the increase of moxibustion time,but when the amount of moxibustion reaches saturation,the therapeutic effect will not increase. |
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